The proposed research will implement a large-scale cigarette smoking cessation program with patients hospitalized for acute myocardial infarction (MI) and elective peripheral vascular surgery (PVS) at Strong Memorial Hospital. The major aims are to (a) demonstrate the effectiveness of a specially designed intervention that is delivered individually to hospitalized patients, (b) determine if strategically timing the intervention can enhance long-term cessation rate, and (c) identify the emotional responses to illness that influence cessation outcome. Within two days of admissions for MI or PVS, patients will be recruited, following informed consent, randomized to one of three cessation conditions: (1) Early vs. (2) Late special intervention; or (3) Usual Care. Early and Late conditions involve an identical 3-session intervention distinguished by the timing of delivery: Early is initiated in the intensive care setting amid the illness crisis, and Late is conducted during the three days prior to hospital discharge at a time of crisis resolution. Usual Care provides a control for routine advice typically given patients regarding smoking cessation. In all conditions, the interventions are portrayed as "standard practice", thus enabling recruitment of a representative sample of patients with cardiovascular disease (CVD) who vary substantially in motivation to quit smoking. Pre- and post-intervention assessments will measure emotional response to illness, knowledge and history of risk factor change, and report of smoking status that is biochemically verified by serum cotinine. Follow-up assessments are repeated at 3-, 6-, and 12-months after discharge to determine long-term smoking status, CVD sysmptoms, and sickness impact. It is hypothesized that the acute crisis of MI will be associated with the greater degree of long-term smoking abstinence. The study will provide empirical support for the clinical observtion that the acute crisis of CVD creates a facilitative opportunity for instigating risk factor modification.